No-Fault Case Law

The relevant facts considered by the court were that the plaintiff filed a complaint to recover first-party no-fault benefits and served the defendant, who failed to answer the complaint and defaulted in the action. The plaintiff subsequently moved for leave to enter a default judgment, which was granted. The main issue decided by the court was whether the defendant should be allowed to vacate the default judgment and dismiss the action based on failure to enter a default judgment within one year of the default. The holding of the court was that the defendant's excuses for failing to oppose the motion for entry of a default judgment and for the delay in moving to vacate the default judgment were insufficient, and the court affirmed the denial of defendant's motion to vacate the default judgment. The court also found that the defendant did not demonstrate a potentially meritorious defense to the action and was not entitled to dismissal of the complaint.

The relevant facts considered in this case involved a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the provider had demonstrated its entitlement to summary judgment, and whether the insurance company had established its defense that the provider had failed to appear for properly scheduled examinations under oath. The holding of the case was that the provider had failed to demonstrate its entitlement to summary judgment, as the affidavit submitted in support of its motion failed to establish that the claim at issue had not been timely denied. However, the insurance company's cross motion for summary judgment dismissing the complaint was also denied, as it failed to establish its defense that the provider had failed to appear for properly scheduled examinations under oath. Therefore, the court modified the order to deny the insurance company's cross motion for summary judgment dismissing the complaint, but affirmed the order in all other respects.

The court considered the plaintiff's appeal from an order of the Civil Court of the City of New York, which granted the defendant's motion to consolidate four related actions and to limit any potential recovery of attorneys' fees in the consolidated action to $850. The main issues decided were whether the $850 limit on attorneys' fees, as provided by Insurance Department Regulations, was properly applied to the claims at issue in the consolidated action and whether the plaintiff's appeal from the portion of the order granting consolidation should be dismissed since the plaintiff had agreed to consolidation. The holding of the court was that the $850 limit on attorneys' fees was properly applied to the claims at issue, and that the plaintiff's appeal from the portion of the order granting consolidation must be dismissed.

The relevant facts in the case were that New Way Medical Supply Corp. as the assignee of Jonathan Trevino appealed from an order of the Civil Court denying plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits from American Transit Ins. Co. The main issue decided was that the plaintiff failed to establish that the defendant had failed to pay or deny the claim within the 30-day period required by Insurance Law, or that the defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. As a result, the plaintiff failed to demonstrate its entitlement to summary judgment. The holding of the case was that the order denying plaintiff's motion for summary judgment was affirmed, with $25 costs.

The court considered that the no-fault benefits claims at issue had been timely and properly denied by the insurance company on the ground that the plaintiff had failed to comply with a condition precedent to coverage, specifically by failing to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the defendant’s proof of mailing the EUO scheduling letters and the denial of claim forms, as well as the plaintiff’s failure to appear, were sufficient to grant the defendant’s motion for summary judgment. The court held that the proof submitted by the defendant established that the scheduling letters and denial of claim forms had been timely mailed and that the plaintiff had failed to appear for the EUOs. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in Metro Health Products, Inc. as Assignee of ANASTACIA PILLOT v State Farm Mutual Automobile Ins. Co. were that the provider was seeking to recover assigned first-party no-fault benefits, and the insurer denied the claims on the basis that the provider failed to comply with the condition precedent of appearing for duly scheduled examinations under oath (EUOs). The main issue decided by the court was whether the insurer had properly denied the claims based on the provider's failure to appear for the EUOs. The holding of the court was that the insurer had timely and properly denied the claims, as it was established that the EUO scheduling letters and denial of claim forms had been timely mailed, and the provider did not respond in any way to the EUO requests. Therefore, the court affirmed the order of the Civil Court, granting the insurer's motion for summary judgment dismissing the complaint.

The relevant facts the court considered are that Longevity Medical Supply, Inc. was seeking to recover first-party no-fault benefits from Praetorian Insurance Company. Longevity Medical Supply, Inc. had moved for summary judgment, which was denied, and Praetorian Insurance Company cross-moved for summary judgment, which was granted. The main issue decided was whether Longevity Medical Supply, Inc. was entitled to summary judgment upon its first cause of action and whether Praetorian Insurance Company was entitled to summary judgment dismissing the complaint. The holding of the case was that the branch of plaintiff's motion seeking summary judgment upon plaintiff's first cause of action was granted and defendant's cross motion for summary judgment dismissing the complaint was denied. This means that Longevity Medical Supply, Inc. was entitled to recover first-party no-fault benefits from Praetorian Insurance Company.

The court considered an appeal from a judgment in favor of Parkview Medical & Surgical, P.C., as assignee of Ralph Allison, against Allstate Insurance Company. The main issue was whether a no-fault provider had established its prima facie entitlement to judgment as a matter of law, based on submitting evidence that claim forms were mailed to and received by the defendant insurer, and whether the defendant had failed to pay or deny the claims within the prescribed 30-day period. The holding of the case was that the judgment in favor of the plaintiff was reversed, the original order was vacated, and the plaintiff's motion for summary judgment was ultimately denied. The court found that the plaintiff had failed to meet its initial burden of establishing its prima facie entitlement to judgment as a matter of law, and there was a triable issue of fact demonstrated by the defendant's evidence.

The main issue in the case was whether the provider could recover assigned first-party no-fault benefits when the insured failed to appear for duly scheduled examinations under oath and independent medical examinations. The court considered the proof submitted by the defendant showing that the scheduling letters for the examinations were timely mailed, and that the insured failed to appear for any of the scheduled examinations. The court also noted that the failure to send a denial in duplicate was not a fatal error. Since the insured's appearance at any properly scheduled examination was a condition precedent to the insurer's liability, the court granted the defendant's motion for summary judgment dismissing the complaint. The relevant facts considered were the timely mailing of the examination scheduling letters and the insured's failure to appear for the examinations.

The relevant facts the court considered in this case were a dispute between an insurance company and a medical provider over the failure of a patient to appear for scheduled independent medical examinations (IMEs), which is a condition precedent to the insurer's liability on a policy. The insurance company, appellant, had motioned for summary judgment dismissing the complaint and submitted evidence that the IME requests had been timely mailed, and that the patient failed to appear for the scheduled IMEs. The medical provider, respondent, had cross-moved for summary judgment and claimed that the insurance company failed to provide discovery responses within the stipulated time. The main issues decided were whether the insurance company had failed to comply with the so-ordered stipulation and whether there was an issue of fact as to whether the insurance company is barred from interposing its defense due to an alleged failure to comply. The holding was that the judgment was reversed, the order granting the plaintiff's cross motion for summary judgment was vacated, and the plaintiff's cross motion for summary judgment was denied, with the appeals court determining that there was an issue of fact as to whether the insurance company is barred from raising its defense.